Surgical Outcomes Following Intrascleral Haptic Fixation Of Multi-Piece Iols Using A Modified Handshake Externalization Method

To describe postoperative visual acuity, astigmatism, and adverse events following intrascleral fixation of a monofocal three-piece intraocular lens (IOL) using the described technique for the correction of aphakia in eyes without capsular support.

The study was conducted at the National Eye Hospital of Sri Lanka from May 2023 to April 2024, with all surgeries performed by a single consultant ophthalmologist or his trainees.

This descriptive analytical study included 20 eyes of 20 patients who underwent intrascleral IOL fixation, (IOL tucking), to correct secondary aphakia caused by complications of cataract surgery. All patients received IOL tucking of MA60AC three-piece IOLs under general or local anesthesia. After a limited peritomy at the 12 and 6 o’clock positions, the IOL haptics were externalized using a handshake haptic transfer technique through two stab wounds 2 mm posterior to the limbus. The externalized haptics were then inserted into 2 mm tunnels fashioned parallel to the limbus, and the conjunctiva was repaired. Postoperative best-corrected visual acuity (BCVA) was assessed one month after surgery, with patients followed for at least six months.

The mean age of the study participants was 58.71 years (range 44-71), with 14 males and 7 females. No major postoperative complications were noted in any patient. All 20 eyes demonstrated appreciable IOL centration, with the IOL haptics were well buried without erosion through the conjunctiva. The mean BCVA was 0.5 LogMAR, with an average of 1.96 diopters of residual cylinder.

The described IOL fixation technique resulted in visual acuity improvements across this cohort of patients with a moderate amount of residual astigmatism. The technique proved to be safe and stable over the medium term.